On the black slope: analysis of the course of a blunt renal trauma collective in a winter sports region

Purpose The aim of this study was to analyze the injury patterns and clinical course of a winter sport dominated by blunt renal trauma collective. Methods Blunt renal trauma cases (N = 106) treated in a Level 1 Trauma Center in Austria were analyzed. Results We encountered 12.3% grade 1, 10.4% grade 2, 32.1% grade 3, 38.7% grade 4 and 6.6% grade 5 renal traumata classified according to the American Association for the Surgery of Trauma (AAST). The mechanisms of injury (MOI) did not have an influence on the frequency of HG trauma (i.e., grade 4 and 5). No concomitant injuries (CIs) were found in 57.9% of patients. The number of patients without CIs was significantly higher in the sports associated trauma group compared to other MOIs (p < 0.01). In 94.3% the primary treatment was a non-operative management (NOM) including 56.6% conservative, 34.0% endourological, and 3.8% interventional therapies. A follow-up computed tomography (FU-CT) was performed in 81.1%, 3.3 days after trauma. After FU-CT, the primary therapy was changed in 11.4% of cases (grade ≥ 3). Comparing the Hb loss between the patients with grade 3 and 4 kidney trauma with and without revision surgery, we find a significantly increased Hb loss within the first 96 h after the trauma in the group with a needed change of therapy (p < 0.0001). The overall rate of nephrectomy (primary or secondary) was 9.4%. Independent predictors of nephrectomy were HG trauma (p < 0.01), age (p < 0.05), and sex (p < 0.05). The probability of nephrectomy was lower with (winter) sports-associated trauma (p < 0.1). Conclusions Sports-associated blunt renal trauma is more likely to occur isolated, and has a lower risk of severe outcomes, compared to other trauma mechanisms. NOM can successfully be performed in over 90% of all trauma grades.

Management outcome of blunt renal trauma in a tertiary level hospital of Bangladesh

Background: The kidney is the commonly injured genitourinary and abdominal organ. Renal injuries are classified by their mechanism: blunt or penetrating. Failure to perform appropriate evaluation and treatment of these injuries may result in significant long term patient morbidity. Objective: To evaluate blunt renal trauma cases at a tertiary level hospital to find out management practices along with patient outcomes. Methods: This prospective observational study was conducted in the Department of Urology of Dhaka Medical College Hospital during the period of January 2011 to December 2012 to observe the management outcome of blunt kidney injuries. Sampling technique was purposive and sample size was 110. After management of blunt kidney injury by either conservatively or by surgical means, some patients were followed up for 2 years and others for less than 2 years. Results: In this study, 90.1% patients were diagnosed and staged by contrast enhanced CT scan. Most of the early grade injuries (grade I-III) were treated conservatively and outcome in terms of surgical conversion and short term complications were favourable. Few bluntly injured grade IV and V required operative interventions. Overall nephrectomy rate was only 3.6%. Haemodynamic instability, associated organ injury, higher grade injury - all were predictive indicators of operative interventions. The study showed that rates of complications were more in higher grade injury, with concomitant other organ injuries and in patients who required blood transfusion (indicator of hemodynamic instability). Conclusion: Most of the blunt kidney injuries can be managed in conservative way with favourable outcome. Mediscope 2021;8(2): 103-111